Sunday, November 10, 2013

Western Kenya - Maternal Ultrasound Screening Programs

This morning I landed in Kisumu, Kenya on a beautiful summer day. Kisumu is the third largest city in the country, located in Western Kenya on Lake Victoria. I traveled via tuk tuk (rickshaw) to the MGH guest house. The road was a little bumpy, as the major road to the airport was under construction. Sometimes the course of growth and development has bumps in the road, but the outcome is undoubtedly worth it.


After adjusting to the time difference, I woke up this morning ready for our first day in the field. Our research team embarked for Kaimosi to perform obstetric ultrasound screening. Kaimosi is a small town/village located 40 kilometers NNE of Kisumu. The drive through the Kenyan countryside was beautiful. The natural beauty helped distract me from the narrow, often unpaved roads that seemed quite treacherous at times.


Upon arrival, we met the hospital administrator who was very gracious. I had the opportunity to tour the hospital grounds and facilities. The resources were quite modest in terms of physical equipment and human resource availability. Additionally, one of the major challenges that the hospital faced was related to energy. The energy grid in the region was somewhat unpredictable. I learned that it was not uncommon for the hospital to go without power for 2 to 3 days at a time.

It was also clear that inpatient care within the hospital was a family endeavor.  Patient families were often present and assisting in caring for their loved ones. Family members would bring food, wash linens and clothes and attend to various needs that are customarily provided as part of inpatient care in the U.S.

As a radiology resident, I was specifically interested in the imaging equipment. While walking through the courtyard, I saw a radiographic film hanging on a clothesline. The film was still wet; the true origin of the term “wet read.”  In addition to plain film radiography, the hospital had a fluoroscopy unit which was used for barium studies.

Utilizing the portable ultrasound machine we brought, we were able to provide obstetric ultrasound screening examinations. The portability and durability of the ultrasound machine as an imaging tool in resource limited areas became quite evident.

Today, we went to Bungoma District hospital, which is 102 kilometers NNW Kisumu. There was a significant amount of activity in and around the hospital. Many patients walked to the hospital from long distances or took boda bodas (motorcycle taxis) to the hospital.
 After arrival to the hospital, we were greeted by the head nurse and the hospital administrator. They were gracious and gave us a tour of the facilities.  While touring the hospital, the various departments signs that posted the prices of various healthcare services ranging from basic services to surgical procedures. It was interesting to see the transparency related to the cost of healthcare which is in contrast to the U.S. healthcare delivery system where the actual cost of care is often unknown, even to healthcare providers. However, the costs of various procedures were often prohibitive for most individuals, given that that main economic activity is sustenance farming.
The obstetric wing was particularly active division focused on obstetrics. There were tens of women who were there for prenatal care.  I learned that the midwives and nurses play an integral role in delivery. Complicated or cesarean section deliveries are triaged to the obstetrician. Similarly, most women traditionally delivered at home with the assistance of midwives, but recent changes in Kenya health policy made it possible for any woman to deliver in a hospital if needed or desired.
The obstetric clinic was nearly overwhelmed by the volume of patients who were presenting for prenatal care. However, the staff was quite organized and integrated us well into their workflow to provide screening obstetric examinations. The patients and staff were appreciative of our contributions and we all appreciated the opportunity to add value to their healthcare.

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